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E-cigarettes a new kind of cool?

WHILE the anti-tobacco activists focused on lobbying government to raise taxes on cigarettes to curb smoking, the tobacco industry has seemingly blindsided them with a new threat – the Electronic cigarettes (e cigarettes).
E-cigarettes and other nicotine delivery devices are intended to be used like a cigarette. They heat up a liquid containing nicotine, to create an inhalable vapour. The liquid is a combination of propylene glycol and vegetable glycerine, both safe for human consumption and can be optionally flavoured with anything from chocolate to fruity pebbles. The vapour is pure nicotine without the tar of cigarette. It is also odourless and harmless to bystanders (second hand fumes).
Dr Faston Goma, Dean of the school of Medicine at the University of Zambia says he did not anticipate that e- cigarettes s would appear on the Zambian market ‘this quickly’ but is not surprised.
“The tobacco industry will look for all ways to sell their commodities, so this very unwelcome development is not entirely surprising” said Dr Goma who is the principle author of the International Tobacco Control Evaluation Project (ITC) Project) Wave 1 survey in Zambia.
“Very cleverly, the producers of tobacco have said the e cigarette is a cessant and is actually helping in getting people to stop smoking, but that’s not necessarily true.”
Alongside other public health specialists, Dr Goma has warned against tobacco derivatives like e- cigarettes, shisha (hubbly bubbly) which is fast gaining traction in Middle Eastern restaurants in Lusaka and other tobacco products and urged government to provide strict legislation on their import.
Dr Goma explains that nicotine is highly addictive and contributes to neuro-degeneration and there is evidence of brain development problems in children and foetuses that have been exposed to nicotine.
He says even the World Health Organisation (WHO) does not recommend the use of any form of nicotine for those who have never smoked or for children and pregnant women.
“We don’t want the public to perceive them as a safer alternative to cigarettes. Children who have never smoked might begin nicotine addiction with e-cigarettes.”
He is concerned about first time smokers too who might be deluded into thinking e-cigarettes are safe, or impressionable youths, who think smoking is ‘cool’.
While it might appear that e-cigarettes are a new phenomenon in Zambia, the trend is likely to catch on, aided by the aggressive marketing of companies like Imperial Tobacco which is distributing to shops in Lusaka.
One vendor in Munali says the sale of the e-cigarettes has been ‘surprisingly good’. Not a smoker himself, he says the product is literally flying off the shelves.
“It’s a real good product .its selling so well, especially among young people who do not want to, or are not allowed to smoke tobacco, or people who want to quit. I even have sales from women who want to stop their husbands from smoking, said the shop owner who did not want to be named.
A medical doctor Dr Sam Ngulube who quit smoking last year agrees that the e- cigarettes could assist in getting people to quit smoking.
He used other nicotine replacement products – patches and gum, to quit smoking, but would prescribe e- cigarettes as he is of the view that there is no substantive evidence that they are harmful, beyond the nicotine they contain.
While admitting that the long-term effects on health and nicotine dependence have yet been established, he says they are certainly preferable to tobacco as they contain far less cancer-causing and other toxic substances.
The e-cigarette market has grown rapidly, and is worth $3 billion says a report from the International Union against Tuberculosis and Lung Diseases. Its popularity especially among the youth has increased in the past five years doubling from 2008 to 2012.  A WHO of 2010 report estimates that there over 400 brands of e- cigs with over seven thousand unique flavours competing for this market.
This worries public health specialist at the Ministry of Health Newton Samutebe who is urging regulation of the importation of e-cigarettes and other nicotine replacement products.
“We now have a wide range of nicotine replacement therapies that are being consumed with no regulation, we now have  big tobacco producers and pharmaceutical companies whose only interest is their bottom line, wanting in on the business… this should be a warning that we need to institute strict regulation.’’
He cites Singapore which has instituted an outright ban on e – cigarettes and South Africa where the Pharmacy Council of South Africa refused to endorse e-cigarettes and instead referred to the Medicines Control Council (MCC). According to a legal opinion published by the Cancer Association of South Africa, e – cigarettes are now regulated as a medicine, and can only be sold in pharmacies.
In Zambia, the regulatory body, the Pharmaceutical and Poisons Regulations has no legislation on e – cigarettes or any of the nicotine replacement therapies on the market as they fall under luxury goods or household groceries, rather than a medicine or tobacco product. And there is no need for regulations says pharmacy student Bushel Matebele who uses e – cigarettes. He says it would be practically impossible to regulate an industry that is morphing as rapidly as nicotine replacement therapies.
“We have a plethora of loss weight products that contain chromium, a potentially harmful substance that are sold alongside cosmetics, why should e -cigarettes be any different? They are all trying to curb an appetite or desire for something.”
Matabele cites a South African study available since 2009, which found that 45% of smokers quit within eight weeks of starting to use e-cigarettes, and participating doctors were unanimous that they were both safe and effective. One called it “the most effective treatment method on the market for quitting tobacco smoking.
But anti-tobacco lobbyists are digging their heels in and stand by the WHO recommendation that all forms of nicotine replacement therapy to help adult smokers quit must be licensed.
“While the nicotine in electronic cigarettes does not pose additional health risks for adult smokers,  the evidence for the effectiveness of e-cigarettes as a method for quitting smoking is limited and not definitive and  requires further research, say Zambia Consumer Protection  Society Muyunda Ililonga who supports the anti-tobacco lobbyists in calling for a regulation or ban on e cigarettes.
Dr. Ngulube says the anti -smoking lobby is being ‘unreasonable’. “The science says nicotine is not harmful and research shows that it helps people stop craving tobacco, so why should they want more research in order to endorse e – cigarette as a cessation method?’.
Dr. Goma insists however, that tobacco is dangerous and whatever derivatives it takes are equally so. “You don’t need science to tell you that.”

Zarina Geloo is a freelance writer specialising in development issues.

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